Zafer Hasan Ali SAK, Funda YALÇIN, Ayşegül Öney KURNAZ, Mehmet GENCER, İrfan ESER, Şamil GÜNAY

Ağır Obstrüktif Uyku Apne Sendromlu Hastalarda Ortalama Trombosit Hacminin Değerlendirilmesi

Amaç: Bu çalışmada ağır tıkayıcı uyku apne sendromlu (OSAS) hastalarda kan koagülabilitesiyle ilişkili Ortalama Trombosit Hacmini (MPV) ve Plateletcriti (PCT) değerlendirmeyi amaçladık. Gereç ve yöntemler: Uyku ünitesinde Eylül 2013 öncesi polisomnografi yapılan 98 hastanın kayıtları retrospektif değerlendirildi. Tüm olgular apne-hipopne indeksine(AHİ) göre AHİ <5 / saat (s=48) AGrubu (kontrol), AHİ ≥ 30 / saat ile B Grubu (s = 50) şeklinde gruplandırıldı. MPVve PCT(plateletcrit) otomatik bir kan hücresi sayacı kullanılarak ölçüldü. Polisomnografik bulgularla, demografik ve kan parametreleri karşılaştırıldı. Bulgular: A ve B grupları arasında MPV (7.17±0.98 karşılık 7.54±1.21fL, p=0.66) ve PCT (0.218±0.06 karşılık 0.212±0.05, p=0.66) açısından anlamlı farklılık bulunamadı. Ağır OSAS grubunda MPV, PCT ile AHİ parametreleri arasında anlamlı korelasyon saptanmadı(r=0.37, p=0.801 ve r=0.61, p=0.624). Sonuç: MPV ve PCT değerlerinde ağır OSAS'lı hastalarda kontrole göre anlamlı yükseklik bulunmadı.Bu bulgular yapılan ilk çalışmaların aksine MPV'nin OSAS'ın ağırlığıyla ilişkili bir parametre olmadığı ve OSAS'ın doğrudan trombosit aktivitesini etkilemediğini düşündürmektedir.

Anahtar Kelimeler:

Tıkayıcı Uyku Apne, Trombosit Sayısı, Trombosit aktivasyonu

Assessment Of Mean Platelet Volume In Patients With Severe Obstructive Sleep Apnea

Objective: In this study we aimed to evaluate the mean platelet volume (MPV) and Plateletcrit (PCT) associated with blood coagulability in patients with severe obstructive sleep apnea syndrome (OSAS). Materials And Methods: The polysomnography recordings of 98 patients admitted to the sleep laboratory before September 2013 were retrospectively evaluated. All cases were grouped according to their AHI value as AHI <5 / h (n = 48) Group A (control) and AHI ≥ 30 / hour and Group B (n = 50). MPV and PCT (plateletcrit) was measured using an automatic blood cell counter. Polysomnographic findings, demographic data and blood parameters were compared. Results: No significant differences were found between Aand B groups with respect to PCT (0.218±0.06 vs. 0.212±0.05, p=0.66) and MPV (7.17±0.98 vs. 7.54±1.21fL, p=0.66). In severe OSAS group, MPV and PCT werenot correlated with AHİ (r=0.37, p=0.801 and r=0.61, p=0.624). Conclusion: MPV and PCT levels werenot higher in severe OSAS group compared to the control group. Unlike previous studies, these findings suggest that MPV isnot associated with the severity of OSAS and OSAS does not directly affect the platelet activity

Keywords:

Obstructive Sleep Apnea, Platelet Count, Platelet Activation,

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1) Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: Eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31(8):1071-8. 2) Wolk R, Kara T, Somers VK. Sleep-disordered breathing and cardiovascular disease. Circulation 2003;108(1):9-12. Review. 3) Minoguchi K, Yokoe T, Tazaki T, et al. Silent brain infarction and platelet activation in obstructive sleep apnea. Am J Respir Crit Care Med 2007;175(6):612-7. 4) Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006;173(8):910-6. 5) Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with orwithout treatment with continuous positive airway pressure: An observational study. Lancet 2005;365(9464):1046-53. 6) Shahar E, Whitney CW, Redline S, et al. Sleepdisordered breathing and cardiovascular disease. Crosssectional results of the sleep hearthealth study. Am J Respir Crit Care Med 2001;163:19-25. 7) Schulz R. The vascular micromilieu in obstructive sleep apnoea.Eur Respir J 2005;25(5):780-2. 8) Ryan S, Taylor CT, McNicholas WT, Ryan S, Taylor CT,McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome.Circulation 2005;112(17):2660-7. 9) Vgontzas AN, Papanicolaou DA, Bixler EO, Kales A, Tyson K,Chrousos GP. Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab 1997;82(5):1313-6. 10) Thompson CB, Eaton KA, Princiotta SM, Rushin CA, Valeri CR. Size dependent platelet subpopulations: relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br J Haematol 1982;50(3):509-19. 11)Briggs C. Quality counts: new parameters in blood cell counting. Int J Lab Hematol 2009;31(3):277-97. Review. 12) Vizioli L, Muscari S, Muscari A, “The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases,” Int J Clin Pract, 2009;63(10):1509-15. 13) Korkmaz L, Korkmaz AA, Akyüz AR, et al., Association between mean platelet volume and coronary artery calcification in patients without overt cardiovascular disease: an observational study. Anadolu Kardiyoloji Dergisi, 2012;(12)1: 35–9,. 14) Geiser T, Buck F, Meyer BJ, et al. In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome. Respiration 2002;69(3):229-34. 15) Hui DS, Ko FW, Fok JP, et al. The effects of nasal continuous positive airway pressure on platelet acti¬vation in obstructive sleep apnea syndrome. Chest 2004;125(5):1768-75. 16) Erden EŞ, Yengil E, Tuncel E, Bilgiç HK, Demirköse M, Motor S, Genç S. Investigation of the relationship between mean platelet volume and obstructive sleep apnea syndrome J Clin Exp Invest 2013;4(4):492-6. 17) Varol E, Ozturk O, Gonca T, et all. Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest 2010;70(7):497-502. 18) Kanbay A, Tutar N, Kaya E, et al. Mean platelet volume in patients with obstructive sleep apnea syn¬drome and its relationship with cardiovascular diseases. Blood Coagul Fibrinolysis 2013;24(5):532-6. 19) Nena E, Papanas N, Steiropoulos P, et al. Mean Platelet Volume and Platelet Distribution Width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity? Platelets 2012;23(6):447-54. 20) Sökücü SN, Özdemir C, Dalar L, Karasulu L, Aydın F, Altın S. Is Mean Platelet Volume Really a Severity Marker for Obstructive Sleep Apnea Syndrome without Comorbidities? Pulm Med. 2014;2014:754839 21) Rahangdale S, Yeh SY, Novack V et all. “The influence of intermittent hypoxemia on platelet activation in obese patients with obstructive sleep apnea,” J Clin Sleep Med. 2011;7(2):172-8.